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Declaration of Commitment to Advance Cultural Safety and Humility in Canada’s Health and Social Care Systems

This Commitment was designed in partnership with a working group of First Nations, Inuit, and Métis representation to meaningfully progress actions that advance cultural safety and humility in health and social services in Canada.

We agree that every individual, organization, and the health and social care system, all have a role to play in addressing the racism and discrimination faced by First Nations, Inuit, and Métis peoples in Canada. We accept responsibility for doing our part in this important journey and we commit to working towards quality health and social services for all.

Health Standards Organization (HSO) and our affiliate partner Accreditation Canada (AC) have three levers to influence culturally safe care. These include co-design of standards, assessment programs and building capacity across health and social care services. These levers are used in settings like hospitals, laboratories, residential and community care as well as education programs that train the health care workforce. These levers are essential to enhance the analysis, learning, and accountability needed to advance culturally safe care across Canada.

While we have made progress towards contributing to developments in cultural safety and humility, after much reflection, we acknowledge that we have not done enough to understand, call out, and address systemic racism experienced by Indigenous peoples.

Our Commitment

HSO and AC declare our commitment to First Nations, Inuit and Métis peoples and Indigenous communities in Canada to take actions within our mandate and co-design resources with Indigenous partners. We commit to addressing systemic racism so that Indigenous peoples and communities can experience culturally safe health care services.

Our declaration of commitment is guided by the following understandings: · The values, principles and calls to action laid out in the Truth and Reconciliation Commission of Canada’s final report and the United Nations Declaration on the Rights of Indigenous Peoples.

  • Cultural safety is “an outcome of respectful engagement based on recognition of the power imbalances inherent in the health system, and the work to address these imbalances” (First Nations Health Authority (FNHA), 2016a).

  • A culturally safe environment for Indigenous peoples is one that is physically, socially, emotionally, and spiritually safe (Turpel-Lafond, 2020a).

  • A culturally safe environment results in an environment free of racism and discrimination, where people feel safe when receiving and providing services and care, and when interacting with the health system (FNHA, n.d.).

  • Practicing cultural safety requires having knowledge of the colonial, sociopolitical, and historical events that contribute to health disparities encountered by Indigenous peoples and perpetuate and maintain ongoing racism and unequal treatment (Allan & Smylie, 2015).

  • Being aware, learning and working humbly on our cultural safety and humility journey, in collaboration with First Nations, Inuit and Métis. Improving Indigenous health and wellbeing is embedded in our vision.


We hear the call for more accountability in all settings where Indigenous peoples receive health and social services. These actions have been prioritized with Indigenous partners as having the ability to make a meaningful difference.

  1. Working in partnership with the FNHA on the British Columbia Cultural Safety and Humility Standard, and exploring the need for a National Standard of Canada with other Indigenous partners.

  2. Developing and embedding more explicit requirements within core and future HSO standards to address Indigenous-specific racism. Beginning in 2022 this will include the new HSO Governance Standard.

  3. Updating assessment instruments and mechanisms to address experiences of racism reported through these tools. This includes collaborating with Indigenous partners to revise the Governance Functioning Tool with survey questions that governing bodies use to assess practices related to address Indigenous-specific systemic racism.

  4. Recruiting Indigenous surveyors and Indigenous patient surveyors in greater numbers.

  5. Improving training and resources for surveyors and client organizations on cultural safety and humility criteria and the treatment of Indigenous peoples in health and social service systems.

  6. Advocating for and integrating cultural competency, including Indigenous-specific cultural competency in entry-to-practice health professional education.

  7. Recruiting and onboarding new team members who identify as First Nations, Inuit, or Métis.

  8. Providing cultural safety and humility training activities for team members.

  9. Delivering Health Canada funded “Improving Integrated Care for Child and Youth Mental Health Initiative” and embed criteria related to Truth and Reconciliation Principles, Indigenous-specific systemic racism and anti-oppression content.

  10. Working with federal/provincial/territorial jurisdictions to implement the Canadian Quality and Patient Safety (CQPS) Framework endorsed by the Government of Canada and several provincial and territorial governments. This framework includes specific actions to end systemic racism of Indigenous peoples and promotes traditional holistic medicine.

  11. Working with Indigenous partners to respond to proposals and advance work that addresses Indigenous-specific systemic racism.

HSO and AC look forward to working with and learning from Indigenous partners as we set out to address systemic racism in more deliberate ways. We know we cannot do this alone. We will actively seek feedback and advice along the way. We will strive to deliver on our commitments with courage, humility, and accountability.


Leslee J. Thompson
CEO, HSO and Accreditation Canada



Institute for Quality Management in Healthcare

506–4711 Yonge Street
North York, ON
M2N 6K8

Phone: 416-323-9540 
Toll-free: 1-877-323-9540


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